Application of Breast Ultrasound Imaging Report and Data System classification in diagnosis of special types of breast cancer / 中华超声影像学杂志

Objective:To investigate the value of Breast Ultrasound Report and Data System (BI-RADS) classification in diagnosis of special types of breast cancer.Methods:A total of 112 patients with special type of breast cancer (112 breast lesions) confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital, Zhejiang University School of Medicine from August 2009 to August 2020. All patients underwent ultrasound before surgery. The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively. Taking histopathological result as the gold standard, the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed. Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results:In the 112 patients, pathological results showed that there were 20 cases of metaplastic carcinoma, 19 cases of invasive carcinoma with medullary features, 16 cases of differentiated carcinoma of apocrine gland, 12 cases of mucinous carcinoma, 12 cases of invasive micropapillary carcinoma, 10 cases of invasive papillary carcinoma, 6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma. Among them, 4 cases (3.5%) were BI-RADS 3, 13 cases (11.6%) were BI-RADS 4a, 42 cases (37.5%) were BI-RADS 4b, 47 cases (42.0%) were BI-RADS 4c and 6 cases (5.4%) were BI-RADS 5. The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43% and 96.43%, respectively. There was significant difference in BI-RADS grade among different special types of breast cancer ( P<0.05). Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin. The nodule size, boundary, echo and posterior echo in breast cancer with different special types showed significant differences (all P<0.05). There was a good consistency between the two physicians (Kappa=0.789). Conclusions:The ultrasonography features of different special types of breast cancer are different. BI-RADS classification has great value in diagnosis of special types of breast cancer.

Significance of age in the ultrasound interpretation of BI-RADS 3 and 4A breast lumps / 医学研究生学报

ObjectiveBoth BI-RADS 3 and 4A breast lumps have certain effects on the clinician's decision of proper treatment. The purpose of this study was to compare the ultrasonic BI-RADS classification and pathological results of breast lumps in patients of different ages, and explore the significance of age in ultrasound interpretation of BI-RADS 3 and 4A breast lumps.MethodsWe selected 728 patients with breast lumps treated in our hospital from Jun. 2014 to Dec. 2017 as research objects. According to different ages, the patients were divided into juvenile group (7-17 years old) , young group (18-40 years old), middle-aged group (41-65 years old) and aged group (> 65 years). Comparison was made between ultrasound results and pathological results and among the incidences of breast malignant masses of BI-RADS 3 and 4A grade of different ages to analyze possible factors that might affect the benign and malignant breast lumps of BI-RADS 3 and 4A.ResultsA total number of 728 patients was included in this study. Compared with pathological results, the rate of malignant breast tumors in BI-RADS 3 and 4A gradually increased with age. As to BI-RADS 3 breast lumps, the malignant rate of BI-RADS 3(6.54%) in aged group was higher than those of juvenile group(0.00%), young group (0%), middle-aged group (0.95%) and the differences were of statistical significance (P<0.05). As to BI-RADS 4A breast lumps, the malignant rate of juvenile group(0%) was lower than those of young group (2.06%), middle-aged group(6.54%) and aged group(25.39%), and the malignant rate in the elderly group was higher than those of the other groups(P<0.05). Logistic results showed age (OR=1.21,95%CI:1.07~1.36) and weight (OR=3.87,95%CI:1.24~12.81) were risk factors for breast cancer.ConclusionAge plays an important role in the ultrasound interpretation of BI-RADS 3 and 4A breast lumps. For young people, clinical assessment of BI-RADS 4A breast lumps by ultrasound can be properly degraded. While for elderly people, clinical assessment of BI-RADS 3 and 4Abreast lumps can be properly upgraded.

Application of S-Detect classification system in diagnosis of breast benign and malignant mass by ultrasound / 中华超声影像学杂志

Objective To investigate the value of S-Detect classification in differential diagnosis of breast mass . Methods The data of forty-seven patients with breast mass lesions ( n=61) from our hospital during January to December in 2016 were retrospectively analyzed . Both the man-made BI-RADS classification ( identified by three different specialist physicians with 2 ,5 and 7 years of experience , respectively) and computer S-Detect classification were performed . The sensitivity ,specificity ,accuracy , positive predictive value and negative predictive value of the man-made BI-RADS classification and S-Detect classification of the benign or malignant diagnosis of breast lumps were calculated . The ROC curve was further plotted ,and the area under the curve ( AUC) of each group was compared ,respectively . Results Sixty-one breast mass lesions were confirmed 36 benign lesions and 25 malignant lesions by pathological biopsy . The sensitivity ,specificity and accuracy of man-made BI-RADS classification were as follows:2-year experience physicians 69 .4％ ,72 .0％ and 70 .5％ ;5-year experience physicians:64 .0％ ,92 .0％ and 75 .4％ ;7-year experience physicians:69 .4％ , 92 .0％ and 78 .7％ . The diagnostic sensitivity , specificity , and accuracy of S-Detect classification were 80 .6％ ,96 .0％ and 86 .9％ . The specificity ,accuracy and positive predictive value of S-Detect classification were significantly higher than those of 2-year experience physicians by BI-RADS classification ( P <0 .05) . The area under the ROC curve of each group was 0 .729 ,0 .786 and 0 .801 for 2 , 5 and 7-year experience physicians , respectively , and 0 .917 for S-Detect classification . Conclusions Compared with the man-made BI-RADS classification ,S-Detect classification has advantages in diagnosis of the benign or malignant of breast mass and is helpful to improve the accuracy of diagnosis , especially for junior physicians .

The significance of breast mammography assisted by hook-wire localization biopsy for BI-RADSⅣand above negative breast lesions / 中国肿瘤临床

Objective:To evaluate the diagnosis significance of breast mammography assisted by hook-wire localization biopsy for BI-RADSⅣand above negative or non-palpable breast lesions. Methods:A total of 48 cases of mammary molybdenum target with BI-RADSⅣlevel and above but with clinical-touched negative or non-palpable breast lesions (including 4 bilateral lesions and 44 uni-lateral lesions;total of 52 lesions) were used in the mammography aided by hook-wire localization biopsy. Results:Among the 52 le-sions, 13 cases were malignant lesions (single), 6 cases were at Stage 0 (accounted for 46.15%), 5 cases were in Stage I (38.46%), and 2 cases were in StageⅡ(15.39%). The remaining 39 cases were benign lesions. Results showed that the detection rate for breast cancer was 25.0%. A total of 39 cases of benign lesions and 10 cases of malignant lesions were found among mammography BI-RADSⅣpa-tients. Zero cases of benign lesions and 3 cases of malignant change were found among BI-RADS Ⅴ patients. The positive rates of breast cancer among BI-RADSⅣandⅤpatients were 25.64%and 100%, respectively. Conclusion:Breast mammography assisted by hook-wire localization biopsy could precisely excise both BI-RADSⅣandⅤnegative/non-palpable breast lesions. This technique can also improve the quality of life and prognosis of patients. It is a safe, accurate, and low-cost diagnostic method. Thus, breast mammogra-phy assisted by hook-wire localization biopsy must be widely used in clinical applications in China.

Data analysis of MRI misdiagnosis and missed diagnosis of breast lesions on clinical, radiologic and pathologic features / 肿瘤研究与临床

Objective To analyze the MRI data of misdiagnosed and missed diagnosed of breast lesions and their histopathological features.Methods Data from 241 breast lesions within 121 patients were recruited in this study.The data included MRI images,uhrasounds and X-ray images were retrospectively interpreted by two radiologist and each lesion was assessed according to the BI-RADS classification.The pathologic features of miss or error diagnosed lesions on MRI were analyzed.Results In 241 breast lesions (malignance 120,bcnign 121),4 lcsions were miss diagnosed on MRI.Thcy were 2 intraductal papillomatosis and 2 fibroadenoma.All was benign.Twenty three lesions were misdiagnosed on MRI.Sixteen were overestimation,including 3 chronic inflammations,3 sclerosing adenosis,2 fibroadenoma,4 fibrocystic changes with or without atypical ductal hyperplasia (ADH),2 intraductal papilloma,1 infiltration of pectoralis major muscle and 1 axillary lymphnode metastasis.Meanwhile,there were 7 lesions were underestimation.These lesions included 2 invasive ductal carcinomas,1 mucinous adenocarcinoma,2 DCIS and 1 blunt duct adenosis with ADH and focal cancerous,1 inflammatory breast cancer underwent chemotherapy.The sensitivity and specificity and accuracy of breast MRI were 95.83 ％ (115/120),72.73 ％ (88/121),84.23 ％ (203/241),respectively.MRI findings had no difference with respect to mammogram or ultrasound was 75.10 ％ (181/241).Conclusion MRI misdiagnosis and missed often occurs in smaller breast lesions,morphologic and hemodynamic malignant manifestation atypical,especially intraductal lesions.MRI diagnosis should be combined with physical examination,X-ray mammogram and ultrasound to improve diagnostic accuracy and reduce missed diagnosis.

Reliability investigation and influential factors analysis of BI-RADS-ultrasound categorization on the benign breast nodules / 中华超声影像学杂志

Objective To evaluate the reliability of benign nodules diagnosed by ultrasound and analyze the probable factors of infecting the BI-RADS ultrasound categorization of breast lesions. Methods A total of 792 cases with initial category 3 assessments on BI-RADS ultrasound categorization consistent with more than 2 years follow-up or pathologic results were contained. The reliability of probable benign lesions were studied retrospectively,and several factors that could influence the categorization were explored such as age,breast lumps size,multiplicity,palpability,and US radiologist's experience referring to ACR-BI-RADS and the new categorizations recommendation. Results Of 792 breast nodules, 781 (98.6%) were benign and 11 (1.4%) were malignant. If the new categorizations recommendation was applied, 35. 1% (278/792) of all cased would have been upgraded to BI-RADS 4,81. 8% (9/11)of malignant tumors would have been found. The breast masses diagnosed by the junior radiologists were more frequently upgraded to BI-RADS 4 than senior radiologists' findings (P <0. 05), the nodules in women 40 years or older and multiple lesions were more frequently upgraded to category 4 (P <0. 01). The presence of palpability and mass size had on significantly influence the BI-RADS US categorization of breast nodules. Conclusions BI-RADS-Ultrasound categorization is relatively reliable to diagnose breast benign nodules. The multiplicity of breast nodules,patient's age and US radiologist's experience were found to have significant influences on the categorizations of probably benign breast nodules.

A retrospective study of ultrasonographic characteristics and clinical factors affecting the BI-RADS classification (probably benign breast lesions) / 中华超声影像学杂志

Objective To investigate how many probably benign lesions on ultrasound(US) fulfilled the published criteria and to evaluate how clinical and personal factors influenced the categorization of breast lesions.Methods A total of 487 lesions in 487 women with more than 12 months follow-up after the initial category 3 assessment on US were included.The initial US images were retrospectively reviewed according to previously published criteria,and evaluated several factors that could influence the characterization of breast lesions in clinical practice such as age,multiplicity,palpability,radiologist 's experience,and lesion size.Results Of 487 lesions,479 (98.36%) were benign and 8 (1.64%) were malignant.Of 487 lesions,203(41.68%) including 8 malignancies were reassessed as category 4.If strict criteria had been applied at initial US examination,the positive biopsy rate would have been only 3.94% (8/203) and 96.06% (195 of 203) biopsies would have been unnecessary.Lesions in women 40 years or older and multiple lesions were more frequently reassessed as category 4 (P = 0.008 and P = 0.006,respectively).The presence of palpability,lesion size,and the radiologist 's experience did not significantly influence the categorization of breast lesions on US.Of 487 probably benign lesions,41.68 % could be classified as category 4 lesions when strict criteria were applied in initial practice.Conclusions The multiplicity of the lesion and the patient 's age were found to have a significant influence on the classifcation of probably benign solid masses.